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Evaluating Changes in Coronary Artery Calcium: An Analytic Method That Accounts for Interscan Variability

John E. Hokanson1, Todd MacKenzie2, Gregory Kinney1, Janet K. Snell-Bergeon1, Dana Dabelea1, James Ehrlich3, Robert H. Eckel4 and Marian Rewers1,5

1 Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, 4200 E Ninth Ave., B 119, Denver, CO 80262.
2 Department of Medicine, Dartmouth College, Hanover, NH.
3 Colorado Heart Imaging, Inc., Denver, CO.
4 Department of Medicine, University of Colorado Health Sciences Center, Denver, CO 80262.
5 Barbara Davis Center for Childhood Diabetes, Denver, CO.



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  		Fig. 1. —Frequency histogram shows distribution of coronary calcium volume scores (CVS) in 1,074 subjects. Y-axis is percentage of subjects in categories of coronary CVS.

 


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  		Fig. 2. —Scatterplot shows interscan difference in calcium volume scores (CVS) of two scans taken 5 min apart compared to mean CVS of two scans for all subjects with at least one CVS greater than 0 mm3. Lines represent 95% confidence intervals for interscan difference. CVS1 = CVS from initial electron beam CT scan, CVS2 = CVS from second electron beam CT scan obtained after 5-min rest.

 


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  		Fig. 3. —Scatterplot shows Bland-Altman plot of absolute value of difference in calcium volume scores (CVS) between scan pairs versus mean CVS of two scan pairs. Line represents nonparametric regression line of absolute value of difference in CVS compared to mean CVS (rho = –0.66, p < 0.0001). LnCVS = natural logarithm transformation of CVS, lnCVS1 = natural logarithm of CVS from initial electron beam CT scan, lnCVS2 = natural logarithm of CVS from second electron beam CT scan obtained after 5-min rest. Rho denotes Spearman's rank correlation.

 


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  		Fig. 4. —Scatterplot shows Bland-Altman plot of absolute value of difference in calcium volume scores (CVS) between scan pairs versus mean CVS of two scan pairs. Line represents nonparametric regression line of absolute value of difference in CVS compared to mean CVS (rho = –0.27, p < 0.001). CVS0.33 = cube root transformation of CVS, (CVS1)0.33 = cube root of CVS from initial electron beam CT scan, (CVS2)0.33 = cube root of CVS from second electron beam CT scan obtained after 5-min rest. Rho denotes Spearman's rank correlation.

 


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  		Fig. 5. —Scatterplot shows Bland-Altman plot of absolute value of difference in calcium volume scores (CVS) between scan pairs versus mean CVS of two scan pairs. Line represents nonparametric regression line of absolute value of difference in CVS compared to mean CVS (rho = 0.00, p = 0.97). CVS0.45 = CVS raised to the 0.45 power, (CVS1)0.45 = CVS raised to the 0.45 power from initial electron beam CT scan, (CVS2)0.45 = CVS raised to the 0.45 power from second electron beam CT scan obtained after 5-min rest. Rho denotes the Spearman's rank correlation.

 


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  		Fig. 6. —Scatterplot shows Bland-Altman plot of absolute value of difference in calcium volume scores (CVS) between scan pairs versus mean CVS of two scan pairs. Line represents nonparametric regression line of absolute value of difference in CVS compared to mean CVS (rho = 0.09, p < 0.15). CVS0.50 = square root transformation of CVS, (CVS1)0.50 = square root of CVS from initial electron beam CT scan, (CVS2)0.50 = square root of CVS from second electron beam CT scan obtained after 5-min rest. Rho denotes Spearman's rank correlation.

 


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  		Fig. 7. —Cumulative probability plot shows absolute value of the difference in the square root–transformed calcium volume scores (CVS) from two electron beam CT scans obtained 5 min apart in 1,074 subjects. Solid line represents cumulative probability line; dashed lines represent 95th and 99th percentiles, respectively. (CVS1)0.50 = square root of CVS from initial electron beam CT scan, (CVS2)0.50 = square root of CVS from second electron beam CT scan obtained after 5-min rest.

 

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